The Artemisinin Resistance in Southeast Asia: An Imminent Global Threat to Malaria Elimination

Malaria remains a leading cause of mortality and morbidity in many low- and middle-income countries. Artemisinin combination therapies (ACTs) have contributed to the substantial decline in the worldwide malaria burden, renewing the optimism that malaria elimination is achievable in some regions of the world. However, this prospect is threatened by the emergence of artemisinin resistance in Plasmodium falciparum leading to clinical failure of ACTs in Southeast Asia. Historically, drug resistance in P. falciparum has emerged in SEA and spread to Africa. Today, resistance to ACTs could reverse all the achievements of control and elimination efforts globally. With no new drug available, P. falciparum malaria must be eliminated from the Greater Mekong before it becomes untreatable

Workplace flexibility and job satisfaction of employees: case study of Singapore SMEs

Workplace flexibility has become a popular topic in human resource management research and practice. This organisational practice often referred to in the literature as flexible work arrangements (FWAs), is purported to be a holy grail in achieving work-life balance and work satisfaction in employees Workplace flexibility refers to work arrangements that allow flexibility on “where” (telecommuting or flexplace) and “when” (schedule flexibility or flexitime) work is completed. Workplace flexibility is being implemented to attract competent and efficient talent in various ways. In Singapore, the main issue is that not many employers understand the rights and applications when it comes to FWA and therefore, do not perceive its impact on employees’ performance. Given this, the purpose of this qualitative research is to discuss the perceptions and understanding of how workplace flexibility might impact job satisfaction of employees in Singapore SMEs, challenges and experiences of implementing FWAs in their workplace and recommendation on how organizations can facilitate job satisfaction through flexible work arrangements with strategic HR practices. Theoretical guidance for this proposed research on the impact of workplace flexibility on job satisfaction is derived on spillover and crossover theory, border theory, and social exchange theory which will be discussed in detail in Literature review. The research was approached with case study qualitative research methodology. Data was collected through interviews and data collection methods will use textual descriptions instead of numerical data. The key findings of generally positive relationship between FWA and Job Satisfaction, lack of systematical implementation on FWAs and the feelings of employees' on FWAs will be discussed in this research paper. The findings and additional insights will be discussed with above mentioned theory and will provide fruitful recommendations for more efficient HR strategy on implementing FWAs in their organizations. This research discusses about Limitation of the study, suggestion for future research and concludes with capitalising on HR FWA Strategies that can benefit effective work arrangement of the organizations to advance their global competitiveness

Effective and cheap removal of leukocytes and platelets from Plasmodium vivax infected blood

<p>Abstract</p> <p>Background</p> <p>Investigations of <it>Plasmodium vivax </it>are restricted to samples collected from infected persons or primates, because this parasite cannot be maintained in <it>in vitro </it>cultures. Contamination of <it>P. vivax </it>isolates with host leukocytes and platelets is detrimental to a range of <it>ex vivo </it>and molecular investigations. Easy-to-produce CF11 cellulose filters have recently provided us with an inexpensive method for the removal of leukocytes and platelets. This contrasted with previous reports of unacceptably high levels of infected red blood cell (IRBC) retention by CF11. The aims of this study were to compare the ability of CF11 cellulose filters and the commercial filter Plasmodipur at removing leukocyte and platelet, and to investigate the retention of <it>P. vivax </it>IRBCs by CF11 cellulose filtration.</p> <p>Methods and Results</p> <p>Side-by-side comparison of six leukocyte removal methods using blood samples from five healthy donor showed that CF11 filtration reduced the mean initial leukocyte counts from 9.4 × 10³per μl [95%CI 5.2–13.5] to 0.01 × 10³[95%CI 0.01–0.03]. The CF11 was particularly effective at removing neutrophils. CF11 treatment also reduced initial platelet counts from 211.6 × 10³per μl [95%CI 107.5–315.7] to 0.8 × 10³per μl [95%CI -0.7–2.2]. Analysis of 30 <it>P. vivax </it>blood samples before and after CF11 filtration showed only a minor loss in parasitaemia (≤ 7.1% of initial counts). Stage specific retention of <it>P. vivax </it>IRBCs was not observed.</p> <p>Conclusion</p> <p>CF11 filtration is the most cost and time efficient method for the production of leukocyte- and platelet-free <it>P. vivax</it>-infected erythrocytes from field isolates.</p

Recent changes in the number of spoon-billed sandpipers Calidris pygmaea wintering on the Upper Gulf of Mottama in Myanmar

The spoon-billed sandpiper Calidris pygmaea, a migratory arctic-breeding shorebird, is one of the world’s rarest birds and its population has undergone a large decline in recent decades. We conducted surveys at its most important known wintering area in the Upper Gulf of Mottama in Myanmar to estimate recent (2009 – 2016) changes in its numbers there. The total number of small shorebirds present in the Upper Gulf was counted and the proportion of them that were spoon-billed sandpipers was estimated from sample scans. These two quantities were multiplied together to give the estimated number of spoon-billed sandpipers in each of four years. Total numbers of combined small shorebird species tripled from 21,000 to 63,000 between 2009 and 2016, coincident with efforts to reduce hunting pressure on waterbirds. However, the proportion of small shorebirds that were spoon-billed sandpipers declined and their estimated absolute numbers fell by about half from 244 to 112 individuals. It is probable that loss of intertidal habitat and shorebird hunting elsewhere on the migration route of the spoon-billed sandpipers wintering at Mottama is causing a continued decline, though this is occurring at a less rapid rate than that recorded from Arctic Russia before 2010. The number of spoon-billed sandpipers wintering on the Upper Gulf of Mottama remains the highest single-site total for this species from any known wintering site. Preventing any resurgence of illegal shorebird hunting and ensuring long-term protection of the intertidal feeding habitats and roost sites in the Gulf are high priorities if extinction of this species is to be averted

Born too soon in a resource-limited setting: A 10-year mixed methods review of a special care baby unit for refugees and migrants on the Myanmar-Thailand border

BackgroundPreterm birth is a major public health concern with the largest burden of morbidity and mortality falling within low- and middle-income countries (LMIC).Materials and methodsThis sequential explanatory mixed methods study was conducted in special care baby units (SCBUs) serving migrants and refugees along the Myanmar-Thailand border. It included a retrospective medical records review, qualitative interviews with mothers receiving care within SCBUs, and focus group discussions with health workers. Changes in neonatal mortality and four clinical outcomes were described. A mix of ethnographic phenomenology and implementation frameworks focused on cultural aspects, the lived experience of participants, and implementation outcomes related to SCBU care.ResultsFrom 2008–2017, mortality was reduced by 68% and 53% in very (EGA 28–32 weeks) and moderate (EGA 33–36 weeks) preterm neonates, respectively. Median SCBU stay was longer in very compared to moderate preterm neonates: 35 (IQR 22, 48 days) vs. 10 days (IQR 5, 16). Duration of treatments was also longer in very preterm neonates: nasogastric feeding lasted 82% (IQR 74, 89) vs. 61% (IQR 40, 76) of the stay, and oxygen therapy was used a median of 14 (IQR 7, 27) vs. 2 (IQR 1, 6) days respectively. Nine interviews were conducted with mothers currently receiving care in the SCBU and four focus group discussions with a total of 27 local SCBU staff. Analysis corroborated quantitative analysis of newborn care services in this setting and incorporated pertinent implementation constructs including coverage, acceptability, appropriateness, feasibility, and fidelity. Coverage, acceptability, and appropriateness were often overlapping outcomes of interest highlighting financial issues prior to or while admitted to the SCBU and social issues and support systems adversely impacting SCBU stays. Interview and FGD findings highlight the barriers in this resource-limited setting as they impact the feasibility and fidelity of providing evidence-based SCBU care that often required adaptation to fit the financial and environmental constraints imposed by this setting.DiscussionThis study provides an in-depth look at the nature of providing preterm neonatal interventions in a SCBU for a vulnerable population in a resource-limited setting. These findings support implementation of basic evidence-based interventions for preterm and newborn care globally, particularly in LMICs

Artesunate/dihydroartemisinin pharmacokinetics in acute falciparum malaria in pregnancy: absorption, bioavailability, disposition and disease effects

AIM: To determine if reported lower plasma concentrations of artemisinin derivatives for malaria in pregnancy result from reduced oral bioavailability, expanded volume of distribution or increased clearance. METHODS: In a sequentially assigned crossover treatment study, pregnant women with uncomplicated falciparum malaria received i.v. artesunate (i.v. ARS) (4mgkg(-1) ) on the first day and oral ARS (4mgkg(-1) ) on the second, or, oral on the first and i.v. on the second, in both groups followed by oral ARS (4mgkg(-1) day(-1) ) for 5 days. Plasma concentrations of ARS and dihyroartemisinin (DHA) were measured by liquid chromatography-mass-spectrometry on days 0, 1, 2 and 6. Controls were the same women restudied when healthy (3 months post partum). RESULTS: I.v. ARS administration resulted in similar ARS and DHA pharmacokinetics in pregnant women with malaria (n= 20) and in controls (n= 14). Oral administration resulted in higher total drug exposure in pregnancy [AUC (95% CI) in (ngml(-1) h)/(mgkg(-1) )] of 55.1 (30.1, 100.0) vs. 26.5 (12.2, 54.3) for ARS, P= 0.002 and 673 (386, 1130) vs. 523 (351, 724) for DHA, P= 0.007. The corresponding median absolute oral bioavailability (F%) was 21.7 (12.6, 75.1) vs. 9.9 (6.0, 36.81) for ARS (P= 0.046) and 77.0 (42.2, 129) vs. 72.7 (42.0, 87.7) for DHA, P= 0.033. Total DHA exposure was lower at day 6 in pregnant women with malaria (P < 0.001) compared with day 0 or 1, but not in the controls (P= 0.084). CONCLUSIONS: This study demonstrates the effects of malaria on oral ARS drug disposition are greater than those of pregnancy. This probably results from a disease related reduction in first pass metabolism. The data are reassuring regarding current dosing recommendations

Chloroquine resistant vivax malaria in a pregnant woman on the western border of Thailand

Chloroquine (CQ) resistant vivax malaria is spreading. In this case, Plasmodium vivax infections during pregnancy and in the postpartum period were not satisfactorily cleared by CQ, despite adequate drug concentrations. A growth restricted infant was delivered. Poor susceptibility to CQ was confirmed in-vitro and molecular genotyping was strongly suggestive of true recrudescence of P. vivax. This is the first clinically and laboratory confirmed case of two high-grade CQ resistant vivax parasite strains from Thailand

Methotrexate Is Highly Potent Against Pyrimethamine-Resistant Plasmodium vivax

Resistance of vivax malaria to treatment with antifolates, such as pyrimethamine (Pyr), is spreading as mutations in the dihydrofolatereductase (dhfr) genes are selected and disseminated. We tested the antitumor drug methotrexate (MTX), a potent competitive inhibitor of dhfr, against 11 Plasmodium vivax isolates ex vivo, 10 of which had multiple dhfr mutations associated with Pyr resistance. Despite high-grade resistance to Pyr (median 50% inhibitory concentration [IC50], 13,345 nM), these parasites were all highly susceptible to MTX (median IC50, 2.6 nM). Given its potency against Pyr-resistant P. vivax, the antimalarial potential of MTX deserves further investigation

Observational study of adult respiratory infections in primary care clinics in Myanmar: understanding the burden of melioidosis, tuberculosis and other infections not covered by empirical treatment regimes.

BACKGROUND: Lower respiratory infections constitute a major disease burden worldwide. Treatment is usually empiric and targeted towards typical bacterial pathogens. Understanding the prevalence of pathogens not covered by empirical treatment is important to improve diagnostic and treatment algorithms. METHODS: A prospective observational study in peri-urban communities of Yangon, Myanmar was conducted between July 2018 and April 2019. Sputum specimens of 299 adults presenting with fever and productive cough were tested for Mycobacterium tuberculosis (microscopy and GeneXpert MTB/RIF [Mycobacterium tuberculosis/resistance to rifampicin]) and Burkholderia pseudomallei (Active Melioidosis Detect Lateral Flow Assay and culture). Nasopharyngeal swabs underwent respiratory virus (influenza A, B, respiratory syncytial virus) polymerase chain reaction testing. RESULTS: Among 299 patients, 32% (95% confidence interval [CI] 26 to 37) were diagnosed with tuberculosis (TB), including 9 rifampicin-resistant cases. TB patients presented with a longer duration of fever (median 14 d) and productive cough (median 30 d) than non-TB patients (median fever duration 6 d, cough 7 d). One case of melioidosis pneumonia was detected by rapid test and confirmed by culture. Respiratory viruses were detected in 16% (95% CI 12 to 21) of patients. CONCLUSIONS: TB was very common in this population, suggesting that microscopy and GeneXpert MTB/RIF on all sputum samples should be routinely included in diagnostic algorithms for fever and cough. Melioidosis was uncommon in this population

Clinical importance of the Mandalay spitting cobra (Naja mandalayensis) in Upper Myanmar – Bites, envenoming and ophthalmia

This is an accepted manuscript of an article published by Elsevier in Toxicon on 03/06/2020, available online: https://doi.org/10.1016/j.toxicon.2020.05.023 The accepted version of the publication may differ from the final published version.© 2020 Elsevier Ltd Examination of 18 cobras brought to three hospitals in the Mandalay Region by patients bitten or spat at by them distinguished 3 monocled cobras (Naja kaouthia) and 15 Mandalay spitting cobras (N. mandalayensis), based on their morphological characteristics. We confirm and extend the known distributions and habitats of both N. mandalayensis and N. kaouthia in Upper Myanmar. Clinical symptoms of local and systemic envenoming by N. mandalayensis are described for the first time. These included local swelling, blistering and necrosis and life-threatening systemic neurotoxicity. More information is needed about the clinical phenotype and management of bites by N. mandalayensis, the commoner of the two cobras in Upper Myanmar. Since the current cobra antivenom manufactured in Myanmar has lower pre-clinical efficacy against N. mandalayensis than N. kaouthia, there is a need for more specific antivenom therapy.Published versio